Mental Health — A Comparison Nobody Makes

Scroll

I've been in psychiatric treatment. Psychosis. This isn't a secret or a cry for help — it's why this topic interests me. When you've been in psychiatry yourself, you eventually ask: What's it like elsewhere? Are people here better or worse off than the rest of the world?

I had no theory. I just wanted to see numbers.

The Numbers — and Why You Shouldn't Trust Them Blindly

First problem: measuring mental health isn't like taking someone's temperature. Every country measures differently. Australia has done detailed population studies for years and finds 42.9 percent have had a mental illness at some point in their lives. Japan comes up with 8 percent — not because the Japanese are doing better, but because nobody talks about it there.

The most comparable data comes from the Global Burden of Disease Study (IHME, 2019), which estimates current mental illness prevalence for each country using the same methodology:

| Country | Any mental disorder | Depression | Anxiety disorder | |---------|---------------------|------------|------------------| | USA | 20.1% | 4.7% | 5.7% | | Australia | 19.4% | 4.5% | 5.9% | | Germany | 17.4% | 4.3% | 5.1% | | Austria | 17.0% | 4.0% | 5.0% | | EU Average | 16.5% | 3.9% | 4.6% | | Italy | 16.5% | 3.3% | 4.4% | | Japan | 13.0% | 2.7% | 3.1% |

Italy sits at the EU average, USA and Australia above it, Japan way below. But these numbers only tell half the story.

Suicide

So I looked up suicide rates. The WHO publishes data from 2021, age-adjusted, per 100,000 people:

| Country | Total | Men | Women | |---------|-------|-----|-------| | Japan | 14.6 | 21.1 | 8.5 | | USA | 14.1 | 22.4 | 6.1 | | Austria | 12.1 | 18.6 | 6.1 | | Australia | 11.3 | 17.0 | 5.7 | | Germany | 10.3 | 15.7 | 5.3 | | EU Average | ~10.2 | ~16.0 | ~5.0 | | Italy | 5.4 | 8.7 | 2.5 | | Worldwide | 9.0 | 12.3 | 5.9 |

This surprised me. Italy has the lowest suicide rate in all of Western Europe. And the male-female gap is huge everywhere — men kill themselves two to four times more often.

But then there's South Tyrol.

South Tyrol — Italian on Paper, Alpine in Reality

There's no separate psychiatric population study for South Tyrol. No ASTAT special publication, no dedicated data. What we know: Trentino-South Tyrol has a suicide rate well above the Italian average — estimates range from 10 to 12 per 100,000, possibly double the national rate. But regional variation in Italy is high, and without clean data specifically for South Tyrol, this remains an approximation.

Research points to a so-called "alpine suicide pattern": mountain regions in the Alps — whether Tyrol, the Swiss Alps, or Savoy — consistently show higher suicide rates than lowland areas across multiple studies. Theories range from geographic isolation to gun access to possible effects of altitude on serotonin levels. There's no scientific consensus, but the correlation keeps popping up.

Culturally, South Tyrol is closer to Austria than Italy. The Germanic reticence about mental health likely has more sway here than the Italian family dynamics that work as an informal safety net in other parts of Italy.

At the same time, South Tyrol inherited one of Europe's thinnest psychiatric networks as part of Italy: Four mental health centers for the entire region — in Bolzano, Merano, Brixen, and Bruneck. A few dozen acute psychiatric beds for 540,000 people.

The Basaglia Law — Italy's Radical Experiment

There's a reason for those few beds. In 1978, Italy became the first country in the world to pass a law gradually closing all psychiatric hospitals. Law 180 — named after psychiatrist Franco Basaglia — replaced asylums with community-based centers. Internationally celebrated. In numbers: Italy today has 7.7 psychiatric beds per 100,000 people (Eurostat, 2023). The EU average is about 70. Germany has 133.

The idea was that communities and families would take over care. Critics say: The communities were never adequately funded. Italy spends about 3.3 percent of its health budget on mental health — low even by global standards, though such figures are hard to compare depending on definitions.

For South Tyrol, this means: few beds, plus a culture where you don't easily go to a psychiatrist.

The USA — Deaths of Despair

The USA is the outlier. 23.1 percent of adults have a diagnosed mental illness — the highest rate among industrial nations. But the real extent shows up elsewhere.

Since 2021, more than 100,000 Americans die annually from overdoses, most from synthetic fentanyl. Economists Anne Case and Angus Deaton coined the term "Deaths of Despair" — suicide, drug overdoses, and alcohol-related liver disease, concentrated among white workers without college degrees.

Depending on the study, 40 to 60 percent of mentally ill Americans receive no treatment whatsoever. Some rural counties don't have a single therapist. Firearms are the most common suicide method, accounting for over half of all suicides.

Japan — Low Numbers, High Price

Japan reports one of the lowest mental illness rates: about 8 percent. Yet a suicide rate of 14.6 — the highest in this comparison. In 2003, there were 34,427 suicides in a single year.

This doesn't add up, and the reason's no secret: In Japan, mental problems are so stigmatized they're not spoken about. The concept of "meiwaku" — not being a burden to others — prevents people from seeking help.

Suicide is the leading cause of death for Japanese aged 10 to 39. That's almost unique globally.

Then there's Hikikomori: an estimated million-plus people who completely withdraw from social life for months or years. The exact number varies by study and definition. And Karoshi — death from overwork — officially recognized as work-related death.

And a detail I didn't expect: Japan has about 260 psychiatric beds per 100,000 people, the world's highest rate. Average stay: 270 days. In most EU countries, it's 25. Italy has 7.7 beds. Japan locks people up, Italy has nothing. Both extremes fail.

Germany and Austria

Germany has the EU's highest psychiatrist density: about 28 per 100,000. Since the 1999 Psychotherapy Act, therapy is covered by insurance — cognitive-behavioral, psychodynamic, and psychoanalytic. Still: three to six months wait for an appointment. And suicide numbers are rising — Destatis reported over 10,300 suicides in 2023, well above the ten-year average.

Austria had one of Western Europe's highest suicide rates in the 1980s — around 20 per 100,000. Since then, nearly halved. One reason: After a cluster of subway suicides, Vienna introduced media guidelines on how newspapers could report suicides. Cases dropped measurably — a connection known in suicide prevention as the "Werther effect" that's since become an international model.

Australia — The Most Honest Numbers

Australia reports the highest figures: 42.9 percent lifetime prevalence. Among 16- to 24-year-olds, almost 40 percent within a year.

Sounds dramatic, but mostly shows Australia looks more closely than others. With organizations like Beyond Blue and the youth network Headspace, there's an openness missing elsewhere.

Still: The Indigenous population has double the rate of mental health issues. The intergenerational trauma of the Stolen Generations persists. Rural suicide rates are significantly higher, services thin, and the culture of toughness prevents men from seeking help.

What's Left

No country has this figured out. The USA has money but no functioning system. Japan has beds but no openness. Germany has therapists but not enough appointments. Italy pulled off the most radical reform but never properly funded it. Australia measures best but still struggles.

And South Tyrol? Caught between worlds. Culturally Germanic, administratively Italian, geographically alpine. With a presumably much higher suicide rate than the Italian average, but Europe's thinnest psychiatric network. No dedicated data, no dedicated study, no dedicated debate.

That's maybe the most striking thing about this whole research project: We don't know. Not because the question's unimportant, but because nobody's asking it.

Sources: WHO Global Health Estimates 2024, IHME Global Burden of Disease Study 2019, Eurostat 2023, NIMH/SAMHSA NSDUH 2022, ABS National Study of Mental Health and Wellbeing 2020–2022, Destatis Causes of Death Statistics 2024, WHO Mental Health Atlas 2020. Fact-check: ChatGPT (OpenAI, May 2025), Gemma 4 26B (local).

Sources